<style type="text/css">
    #ajaxModal{z-index: 799!important;}
</style>
<script type="text/javascript" src="{URL_WEB_JS}diyarea.js"></script>
<form class="form-horizontal form-validate" action="{php echo web_url('wxchannels/channelsapply/addstoreapi')}" method="post" enctype="multipart/form-data">
    <div class="modal-dialog">
        <div class="modal-content">
            <div class="modal-header">
                <button data-dismiss="modal" class="close" type="button">×</button>
                <h4 class="modal-title">更新商户客服信息</h4>
            </div>
            <div class="modal-body form-horizontal">
                <div class="form-group">
                    <div class="col-sm-2 control-label">客服联系方式</div>
                    <div class="col-sm-9">
                        <input type="number" class="form-control" value="{$storeInfo['service_agent_phone']}" placeholder="请输入客服联系方式" name="service_agent_phone" />
                    </div>
                </div>
                <div class="form-group">
                    <div class="col-sm-2 control-label">退货接收地址</div>

                    <div class="row row-fix js-address-selector selectArea">
                        <div class="col-md-3" id="tpl-province">
                            <select name="districts[province]" data-value="{$districts['province']}" level="1" class="form-control tpl-province changeArea">
                                {loop $province $item}
                                <option value="{$item['id']}" {if $item['id'] == $province_id}selected="selected"{/if}>{$item['name']}</option>
                                {/loop}
                            </select>
                        </div>
                        <div class="col-md-3" id="tpl-city">
                            <select name="districts[city]" data-value="{$districts['city']}" level="2"  class="form-control tpl-city changeArea">
                                {loop $city $item}
                                <option value="{$item['id']}" {if $item['id'] == $city_id}selected="selected"{/if}>{$item['name']}</option>
                                {/loop}
                            </select>
                        </div>
                        <div class="col-md-3"  id="tpl-district">
                            <select name="districts[district]" data-value="{$districts['district']}" level="3"  class="form-control tpl-district changeArea">
                                {loop $district $item}
                                <option value="{$item['id']}" {if $item['id'] == $district_id}selected="selected"{/if}>{$item['name']}</option>
                                {/loop}
                            </select>
                        </div>
                    </div>

                </div>
                <div class="form-group">
                    <div class="col-sm-2 control-label">详细地址</div>
                    <div class="col-sm-9">
                        <input type="text" class="form-control" value="{$storeInfo['default_receiving_address']['detailed_address']}" placeholder="请输入默认退货邮寄详细地址" name="detailed_address" />
                    </div>
                </div>
                <div class="form-group">
                    <div class="col-sm-2 control-label">退货接收人姓名</div>
                    <div class="col-sm-9">
                        <input type="text" class="form-control" value="{$storeInfo['default_receiving_address']['receiver_name']}" placeholder="请输入退货接收人姓名" name="receiver_name" />
                    </div>
                </div>
                <div class="form-group">
                    <div class="col-sm-2 control-label">退货接收人电话</div>
                    <div class="col-sm-9">
                        <input type="tel" class="form-control" value="{$storeInfo['default_receiving_address']['tel_number']}" placeholder="请输入退货接收人联系方式" name="tel_number" />
                    </div>
                </div>
            </div>
            <div class="modal-footer">
                <button class="btn btn-primary" type="submit">提交</button>
                <button data-dismiss="modal" class="btn btn-default" type="button">取消</button>
            </div>
        </div>
    </div>
</form>
